GET THE

EDUCAT!t
MATTERS

BEST

OF BOTH

.. 11=

welimark.+,V

FARM BUREAU

Products available at Farm Bureau Financial Services

2016 FARM BUREAU INDIVIDUAL AND FAMILY PLANS

GET THE

Well mark"

BEST

+.v.

Wellmark Blue Cross Blue Shield of Iowa

Wellmark Health Plan of Iowa, Inc.

OF BOTH

1.=

FARM BUREAU

Products available at Farm Bureau Financial Services

Picking a new health insurance plan can

INSIDE:

be overwhelming. But with the help of this

Decoding the jargon . . . . . . . . .

Narrowing your options . . . . . . .

guide, you'll know some key questions to ask

Farm Bureau ExclusiveCopayPlans

Farm Bureau Exclusive

High-Deductible Health Plans . . . ..

CopayWellmark Blue RewardsPlans..

yourself so you can enroll in a health plan that

best fits your life and budget. You'll also find

Understanding your benefits

10

important information about different types of

coverage, networks and all the Wellmark Blue
Cross and Blue Shield plans offered by Farm
Bureau that meet your personal needs.

MORE THAN JUST

HEALTH INSURANCE
Trust your local Farm Bureau agent to help
protect you and your family from medical
costs. Becoming a member of the Iowa
FarmBureau is a simple and powerful way

By choosing Wellmark and Farm Bureau, you

to support your fellow Iowans,while having

specialadvantagesright at yourfingertips.

can feel confident joining the hundreds of

With Farm Bureau,you haveexclusive

accessto insurance service options, along

thousands of Iowans who have already picked

with discounts on entertainment and

travel. Find out how you can harnessthe

a Wellmark Blue Cross and Blue Shield plan.

power of community today.

We've been providing trusted coverage and

customer service to Iowans for 75 years, and
we look forward to serving you.

Plan Comparison Guide 2016 I 1

DECODING THE JARGON

Before choosingyour health plan, understand these key terms.
>

Premium - What you'll pay each month for your health

insurance benefits.

>

Coinsurance - Your share of the costs for a covered health

care service, calculated as a percent. You must typically reach
your deductible before your coinsurance applies. However,
dependingon your plan benefits, your deductible maybe waived.

>

Deductible - The amount you owe for health care services

that your plan covers before your health plan begins to pay.
Some plans waive the deductible for certain services, which
- means your benefits kick in immediately.

>

Out-of-pocket maximum (OPM)- The most you pay during a

policy period (usuallya year) before your health plan beginsto
pay 100 percent of the allowed amount. This doesn't include
your premium or the cost for health care your health plan
doesn't cover.

>

Personal doctor- The provider you choose as your personal

family physician at the time you enroll in your Wellmark health
plan. Choosinga personal doctor can lead to better health
outcomes because he/she knows your family history, oversees
all treatments, manages chronic conditions, knows your
prescriptions, helps you havea healthy lifestyle and assists
with coordinating care.

>

>

In-network - An in-network provider is one who has an

agreement with Wellmark to provide services to members for a
negotiatedrate. Using providersthat are in-network meansyou'll
pay lessout of your own pocket for care, savingyou money.

>

Out-of-network - An out-of-network provider does not have

an agreement with Wellmark to provide services to members at
a negotiated rate. If you use an out-of-network provider, you'll
pay more out-of-pocket for services than if you used an
in-network provider. You may also be responsible for paying
the difference between the amount a provider charges for the
service and the maximum amount that Wellmark will pay for
that procedure or service.

>

Benefit year - A 12-month period of benefits coverage under

your health plan. For individual and family plans, this runs
Jan. 1 to Dec. 31. You'll see this term with regards to the OPM
accumulations. Amounts you spend out-of-pocket for
applicable covered items and services from Jan. 1 to Dec. 31
will go toward the OPM.

>

Open Enrollment Period (OEP)- The OEPis the yearly time

period when you can make adjustments to your health
coverage for the next year.

>

Special Enrollment Period (SEP)- An SEP is a window of time

when you can apply for health coverageor make a changeto
your current coveragedue to a qualifying life event. Qualifying
life eventsare major changes like getting married, havinga baby
or losing coveragethrough a moveor job loss. The only way you
can change your coverageoutside of the OEPis through an SEP.

Copay - A fixed amount (for example, $15) you pay for a

coveredhealth care service, usuallywhen you receivethe service.

>

>

Silver, Gold or Platinum) based on the portion of claims paid by

the insurer. Metallic tiers make it easier for you to compare
plans and, typically, the more coveragea plan offers, the more
you'll pay in premiums. At Wellmark, we have plans for
individuals and families in the Bronze, Silver and Gold tiers.

Primary care provider (PCP)- A type of provider that delivers

primary care. PCPs includefamily practitioners,general
practitioners, internal medicine practitioners, obstetricians/
gynecologists,pediatricians,physicianassistantsand advanced
registered nurse practitioners.
Metallic tiers - Due to the Affordable Care Act (ACA),the
federal government created four categories of coverage or
"metallic tiers." Plansare assigned a metallic tier (Bronze,

WHAT'S AN HSA?

2 I PlanComparisonGuide2016

NARROWING YOUR OPTIONS

Considerthese important questions when choosing a plan.
When looking at your plan options, remember to not only consider your potential costs for today, but alsofuture costs. Rememberthat
costs are more than just your monthly premium. Out-of-pocket expensescome from things like deductible amounts, copayments and
coinsurance for doctor visits, hospital stays, lab work, prescription drugs, and emergency room visits.

o What kind of network best fits your needs?With Wellmark, e What components of a health plan contribute to the total
you feel protected knowing you can get the coverageyou need
when and where you need it. Youcan choose from three types
of networks:

>

>

>

out-of-pocket cost?
> Monthly premiums are a large part of the overall cost of health
insurance.What you pay each month on premiums does not
go toward your deductible or out-of-pocket maximum (OPM),
but should be considered when picking a health plan.

Wellmark Blue PPOSM plans give you the freedom and

convenience to get health care from any provider who
participates with a Blue Cross Blue Shield plan. Keep in
mind, choosing a network provider will reduce your out
of-pocket costs.

>

Wellmark Blue HMosMplans cover care here in Iowa.

100 percent of hospitals and 96 percent of doctors from
Iowa are in the network. Don't worry - you can still get
out-of-state coverage in emergency and accidental
injury situations.

Deductibles for in-network and out-of-network services

are another part of your total costs. A plan with a higher
deductible may saveyou money in monthly premiums, but
you may haveto cover a larger portion of your health care
services before benefits begin.

>

OPMsalso affect your costs. Typically,the higher the OPM,

the lower the monthly premium.

Wellmark Blue RewardsPOSSM plans let you choose how to

use it everytime you need care. The amount you pay out-of
pocket is determined by the tier your provider is in, and you'll
pay less by seeing Blue Rewardsproviders. The Wellmark
Blue RewardsPOS network plans are unique to Wellmark
and evenallow you to earn rewardsfor healthy behavior.

o Are you interested in potentially saving money on your taxes or

saving for your retirement? Choosinga high-deductible health
plan and putting dollars in a tax-advantaged health savings
account (HSA)to payfor qualified medical expensesis one way
to keep your premium down. Plus,the funds you put into your
HSAare generally tax-deductible.

o Are your prescriptions covered at the cost-share level you want

to pay?Everyplan covers prescription drugs a little differently.
Before choosing a plan, be sure to understand the different tiers
of the Blue Rx Essentials='drug plan. For a quick overviewof the
tiers, turn to page 10 of this guide. You can also easilysearch for
your specific prescription drug on Wellmark.com.Just look for
the Wellmark Drug List.

Wellmark helps you feel secure through the "what ifs"

You may be healthy today, but what happens if you havea health issue tomorrow?
When considering a plan from Wellmark, make sure you're comfortable with how
much you may haveto pay out-of-pocket for health care costs if the "what if"
happens. Either way, Wellmark's plans help you feel confident knowing you'll be able
to get the health care you need when and where you need it.
Quick Tip: Usethe questions on page 13 to assessyour needs for today and tomorrow.

PlanComparisonGuide2016 I 3

FARM BUREAU EXCLUSIVE COPAY PLANS

EnhancedBluesM Gold

....... \

$1,000/
$2,000

11

20%

40%

$3,500/
$7,000

$6,5001

$14,000

Not
applicable

$18,900

Not
applicable

$19,200

Not
applicable

Unlimited

Unlimited

Unlimited

Unlimited

Unlimited

Unlimited

Unlimited

Unlimited

1000 PPO/HMO
Single / Family"

$1,0001

HMO
$

$2,000

SILVER-OO

Completeblue'"
Silver 2500

PPO/HMO
Single / Family2

jj I

1\

1$

$2,5001

PPO ~

CompleteBlueSM
Silver 3500

PPO/HMO

1$

$3,5001

$7,000

HMO
$

~
SimplyBlueSM Bronze

30%

30%

Not
applicable

50%

Not
applicable

50%

$3,5001

$7,000

$6,8501

$13,700

$9,8501

$6,8501

$13,700

$6,6001

$13,200

$9,6001

Single / Family2

$5,000

20%

30%

$5,000

$2,5001

HMO
SILVER-OO

BRONZE-O

$3,5001

gl

$7,000

$5,000/
$10,000

30%

50%

Not
applicable

50%

$6,6001

$13,200

$6,8501

$13,700

$13,700

$9,8501

$18,700

Not
applicable

5000 PPO/HMO
Single / Family2

$5,0001

HMO

$10,000

50%

Not
applicable

$6,8501

As a young adult, you may not go to the doctor for anything other than a
yearly preventive exam. However, you also may not have the disposable
income to pay for medical costs if a catastrophic event happens. That's
why you may want to consider benefit-rich plans with a monthly premium
you can build into your budget:

ALAN
Age: Mid 20s
Status: Single
4 I PlanComparisonGuide 2016

>
>
>

CompleteBlue Silver 3500 HMO (See above)

EnhancedBlue Gold 1000 HMO (See above)
myBlue HSNM Gold 2100 HMO (See page 6)

0=

PCP3: $25 copay

Non-PCP: $50 copay

Ded~ctible and
coinsurance
apply

Ded.uctibleand
coinsurance
apply

Ded.uctible and
coinsurance
apply

Not
applicable

Deductible and
coinsurance
apply

Not
applicable

Ded.uctible and
coinsurance
apply

Ded.uctible and
comsurance
apply

Deductible and
coinsurance
apply

Deductibleand
coinsurance
apply

Deductible
and
.
cornsurance
apply

Not
applicable

Deductibleand
coinsurance
apply

Not
applicable

Deductible and
coinsurance
apply

PCP3: $40 copay

Non-PCP: $70 copay

Deductibleand
coinsurance
apply

Deductible and
coinsurance
apply

Deductible and
coinsurance
apply

Ded.uctible and
comsurance
apply

PCP3: $40 copay

Non-PCP: $70 copay

Not
applicable

Deductible and
coinsurance
apply

Not
applicable

Ded.uctible and
coinsurance
apply

PCP3: $60 copay

Non-PCP: Deductible
and coinsurance apply

Deductible and
coinsurance
apply

Deductible and
coinsurance
apply

Deductible and
coinsurance
apply

Ded.uctible and
comsurance
app~

PCP3: $25 copay

Non-PCP: $50 copay

-PCP3: $40 copay

Non-PCP~$70 copay

PCP3: $40 copay

Non-PCP: $70 copay

PCP3: $60 copay

. Non-PCP: Deductible
and coinsuranceapply

Ded.uctible and
comsurance
apply

I
I

I
I

I
I

Ded.uctible and
coinsurance
apply

Not
applicable

Not
applicable

Ded.uctibleand
coinsurance
apply
Not
applicable

Ded.uctible and
coinsurance
app~

Deductiblewaived
/"t~ I Tier
1. $5

$300 co a
D
dit
d)
waIve I a mt e

$300 copay
(waivedif admitted)

Deductibleand
.
comsurance
apply

$350 ~~.

(waivedif admitted)

$350 copay

(waivedifadmitted)

$350 copay

(waivedif admitted)

$350 copay
(waivedifadmitted)

Premium

Tier 2: $35
Tier 3: $70
Preferred specialty: $100
Non-preferredspecialty:
50% coinsurance

Deductiblewaived
Tier 1: $5
Tier 2: $35
Tier 3: $70
Preferred specialty: $100
Non-preferred specialty:
50% coinsurance

Deductible waived
Tier 1: $5
Tier 2: $35
Tier 3: $70
Preferred specialty: $100
Non-preferred specialty:
50% coinsurance

Deductible and
coinsurance
apply
Deductible and
coinsurance apply

Not
applicable

Ded.uctible and
coinsurance
apply

Not
applicable

Deductibleand
coinsurance
apply

Not
applicable

Deductibleand
coinsurance
apply

How do copay and coinsurance amounts work with my plan?

With a copay plan, you'll have a certain amount you have to pay out-of-pocket for regular
doctor visits and prescription drugs. Your deductible is typically waived for these services.
Deductible and coinsurance may still apply for major services like surgery or hospitalization.

Both in-network and out-of-network services apply toward a single deductible. However, out-of-pocket costs for in-network services apply to the in-network out-of-pocket maximum only. Out-of-pocket costs for
out-of-network services apply to the out-of-network out-of-pocket maximum.
The family deductible can be met through any combination of family members. No one member will be required to meet more than the single deductible amount to receive benefits for covered services
during a benelit period.
The primary care office copay applies to family practitioners, general practitioners, internal medicine practitioners, obstetricians/gynecologists, pediatricians, physician assistants and advanced registered nurse
practitioners. This lower office copay also applies to in-network chiropractors, physical therapists, occupational therapists, speech pathologists, and in some cases, mental health or chemical dependency visits. All
other in-network practitioners are subject to the non-primary care office copay. The copay applies per practitioner, per date of service.
Plan Comparison

Guide 2016 I 5

FARM BUREAU EXCLUSIVE HIGH-DEDUCTIBLE HEALTH PLANS

myBlue HSAsM Gold 2100

PPO/HMO
Single 1 Family1

0%

$3,5001
$7,000

0%

0%

$3,5001
$7,000

$6,0001
$12,000

0%

$6,0001
$12,000

0%

SILVER-OO

I/,"

J I

1\

BRONZE-O

Single 1 Family

$2,1001
$4,200

myBlue HSAsM Bronze

6000 PPO/HMO

1$

myBlue HSAsM Silver 3500 1 $

PPO/HMO
Single 1 Family

$2,1001
$4,200

1\

'II

1/

II

1$
I

HMO
$

0%

20%
1

I
I

Not
applicable

30%

Not
applicable

50%

Not
applicable

I
I

I
I

$2,1001
$4,200

$4,2001
$8,400

Unlimited

$2,1001
$4,200

Not
applicable

Unlimited

$7,0001
$10,000

Unlimited

$3,5001
$7,000

$3,5001
$7,000

$6,0001
$12,000

$6,0001
$12,000

Not
applicable

Unlimited

$9,5001
$18,000

Unlimited

Not
applicable

Unlimited

Some Wellmark health plans may help you save for medical costs
and your future. A high-deductible health plan, paired with HSA
contributions, can earn interest and be invested, so it's a great way

JOE AND MARTHA

Age: Mid 50s
Status: Married and looking
forward to retirement

6 I PlanComparisonGuide2016

to save. It can also help you plan for medical costs after you reach
age 65. Interest and investment earnings are generally not subject
to federal income tax. Any remaining balance you have in your HSA
rolls over each year. That's why you may want to consider:

>
>
>

myBlue HSA Silver 3500 PPO (See above)

myBlue HSA Bronze 6000 PPO (See above)
Completefslue-" Silver 3500 PPO (See page 4)

0=

Deductible applies

Deductible and
coinsurance
apply

Deductible
applies

Deductible and
coinsurance apply

Deductible
applies

Deductible and
coinsurance apply

Deductible
applies

Premium

Deductible
applies

Deductible applies

Not
applicable

Deductible
applies

Not
applicable

Deductible
applies

Not
applicable

Deductible
applies

Deductible
applies

Deductible-applies

Deductible and
coinsurance
apply

Deductible
applies

Deductible and
coinsurance apply

Deductible
applies

Deductible and
coinsurance apply

Deductible
applies

Deductible
applies

Deductible applies

Not
applicable

Deductible
applies

Not
applicable

Deductible
applies

Not
applicable

Deductible
applies

Deductible
applies

Deductible applies

Deductible and
coinsurance
apply

Deductible
applies

Deductible and
coinsurance apply

Deductible
applies

Deductible and
coinsurance apply

Deductible
applies

Deductible
applies

Deductible applies

Not
applicable

Deductible
applies

Not
applicable

Deduc.tible
applies

Not
applicable

Deductible
applies

Deductible
applies

What makes myBlue HSA plans different?

Wellmark's myBlue HSA plans are actually qualified high-deductible health plans (HDHPs).
They're different from any other health plan because they don't include co payments and
coinsurance for in-network services. That means you pay the full cost for care (excluding
preventive care) and prescriptions until you reach your deductible. With a qualified HDHP,
you can open a health savings account (HSA). These are savings accounts you can use to
set aside money, which grows tax free, and then withdraw funds from, generally on a
tax-free basis. You can use this money to pay for qualified medical expenses, like doctor's
office visits and prescription drugs. Any interest gained is also typically not subject to federal
income tax.

Both in-network and out-or-network services apply toward a single deductible. However, out-of-pocket costs lor in-network services apply to the in- network out-of-pocket maximum only. Out-of-pocket costs lor
out-ai-network services apply to the out-of-network out-of-pocket maximum.

For the myBlue HSA bronze and silver health plans, no one member will be required to meet more than the single deductible. For the myBlue HSA gold health plan, the entire lamily deductible must be met
before benefits are payable.
Plan Comparison Guide 2016

I 7

COPAY WELLMARK BLUE REWARDssM PLANS

Blue
RewardssM

GOLD-OOO

pas

1000
Single / Familyl

Blue
RewardssM

SILVER-OO

pas

1500
Single / Family2

Blue
RewardssM

BRONZE-O

5500
Single / Family2

pas

Tier 1 = Wellmark Blue Rewards pas providers

$1,0001
$2,000

$2,0001
$4,000

$1,5001
$3,000

$3,0001
$6,000

$5,5001
$11,000

$6,6001
$13,200

Tier 2 = Wellmark Blue

$4,0001
$8,000

20%

$6,0001
$12,000

30%

$8,0001
$16,000

50%

pas providers

30%

40%

50%

40%

50%

60%

$2,0001
$4,000

$4,0001
$8,000

$6,5001
$13,000

$6,8501
$13,700

$9,0001
$18,000

$6,8501
$13,700

$6,8501
$13,700

$9,0001
$18,000

Tier 3 = Out-of-network providers

LET WELLMARK HELP YOU SAVE.

Wellmark, Hy-Vee3 and UnityPoint Health are excited to collaborate to bring you three plan
options called Wellmark Blue Rewards.
Blue Rewards plans are only available in certain counties. Visit WellmarkBlueRewards.com to see if it's offered in the county you live.
By choosing one of these plans, you have access to:

wellmark."
A quality Wellmark plan that lets
you choose how to use your
benefits when you need care.

8 I Plan ComparisonGuide2016

II

UnityPoint Health

The physicians and hospitals

of UnityPoint Health are located
where you live, work and play.
With this access, you'll see the
lowest out-of-pocket costs
when you get care from Blue
Rewards providers.

HqVoo.
Coverage for prescriptions
filled exclusively at Hy-Vee
pharmacies, as well as
consultations with registered
Hy-Vee dietitians for a copay.

Rewards for healthy

behavior. With Blue Rewards,
you have the chance to earn
rewards for behaviors that
support better health.

$6,0001
$10,000

0=

PCP4: $15
Non-PCP: $30

Deductible and
coinsurance
apply

PCp4: $30
Non-PCP: $60

PCP4: $45
Non-PCP: $90

Deductible and
coinsurance
app~

Ded.uctible and
comsurance
apply

Ded.uctible and
comsurance
app~

Ded.uctible and
coinsurance
apply

Deductible and
coinsurance
apply

Ded.uctible and
comsurance
app~

Deductible and
coinsurance
apply

Deductible and
coinsurance
apply

Ded.uctible and
coinsurance
app~

Deductible and
coinsurance
apply

Deductible and
coinsurance
apply

$250 copay
(waivedif admitted)

$350 copay
(waivedif admitted)

Deductible and
coinsurance apply

Premium

Hy-Vee Pharmacies Only5

Deductible waived
Tier 1 drugs: $10
Tier 2 drugs: $35
Tier 3/preferred specialty: $70
Non-preferredspecialty drugs: 50% coinsurance
Hy-Vee PharmaciesOnly5
Deductible waived
Tier 1 drugs: $10
Tier 2 drugs: $35
Tier 3/preferred specialty: $70
Non-preferredspecialty drugs: 50% coinsurance
Hy-Vee PharmaciesOnly5
Deductible applies (waivedfor Tier 1)
Tier 1 drugs: $25
Tier 2, Tier 3/Preferred specialty,
Non-preferredspecialty drugs: Tier 1
deductible and coinsurance apply

How do Blue Rewards plans work?

Well mark Blue Rewards POSSM plans combine elements of both PPO and HMO plans. The amount you
pay out-of-pocket is determined by the level of provider care you choose, so if you see a Blue Rewards
provider, you'll spend less on health care expenses. You can also earn rewards for healthy behavior.
With Blue Rewards, you have coverage when seeing BlueCard providers outside of Iowa. Depending
on the plan you choose, the BlueCard deductible and BlueCard out-of-pocket maximum (OPM) may
be the same as when receiving care from a Tier 2 Wellmark Blue POS provider. The BlueCard
deductible and OPM may also be the same as when receiving care from an out-of-network provider.
The coinsurance amount for BlueCard providers is always the same as when seeing out-of-network
providers. For more information on out-of-pocket costs when seeing BlueCard providers, along with
how they apply to your OPM, visit WellmarkBlueRewards.com.
1

Both Tier 1 and Tier 2 deductible amounts count toward each other, but do not apply toward BlueCard or Tier 3 out-of-network deductibles. Tier 1, Tier 2 and BlueCard expenses count toward each others
out-of-pocket maximums WPM), and out of network expenses apply to Tier 3 OPM. Tier 1 and Tier 2 out-of-pocket maximum amounts will also count toward each other.
The family deductible can be metthrough any combination offamily members. No one member will be required to meet more than the single deductible amountto receive benefits for covered services during a
benefit period.
Hy-Vee is an independent company providing affinity/rewards services in support of the Blue Rewards program.
The primary care office copay applies to family practitioners, general practitioners, internal medicine practitioners, obstetricians/gynecologists, pediatricians, physician assistants and advanced registered nurse
practitioners. This lower office copay also applies to in-network chiropractors, physical therapists, occupational therapists, speech pathologists, and in some cases, mental health or chemical dependency visits. All
other in-network practitioners are subject to the non-primary care office copay. The copay applies per practitioner, per date of service.
You may only fill prescriptions at Hy-Vee pharmacies with limited exceptions. You can get more information about prescriptions filled at other pharmacies in your policy manual, which you will receive
after enrollment.
Plan Comparison Guide 2016 I 9

UNDERSTANDING YOUR BENEFITS

No matter which plan you choose, feel secure knowing you are always covered with
Essential Health Benefits (EHBs).

Preventive and wellness service and chronic

disease management

o
e

Pediatric services, including vision care

Emergency services

Prescription drugs

o Ambulatory patient services

o
o
o
o
C

Hospitalization
Laboratory services
Maternity and newborn care
Mental health and substance use disorder services,
including behavior health treatment
Rehabilitative and habilitative services and devices

PREVENTIVE BENEFITS

PEDIATRIC BENEFITS

At Wellmark, we design our insurance plans with you in mind. All

the plans in this booklet cover preventive care from in-network
and participating providers at no cost to you. Preventive services
include things like physical exams, immunizationsand screenings.
If you choose an HMO or Blue Rewards plan, you must see your
designated personal doctor or OB/GYNfor your annual wellness
and gynecological exam.

Children, under age 19, covered under your plan are now
protected with vision benefits.

PRESCRIPTION

PEDIATRICVISION - Wellmark's pediatric vision benefits

are administered through Avesis', Wellmark's preferred
vision vendor.

>

Benefits are available for children under age 19. Your

deductible is waived for all plans except myBlue HSA.
myBlue HSA plans will waive the deductible for routine
vision exams only.

>

For myBlue HSA plans where the deductible and out-of

pocket maximum (OPM) are equal- once the deductible/
OPM are reached - there's no additional cost to you for
pediatric benefits.

>

The details

DRUG BENEFITS

All plans have the Blue Rx EssentialssM drug plan to help cover
your medication costs.
BENEFIT LEVELS

>

Drug Tier 1: Most affordabledrugs

Includes most generics and select brand name drugs.

>

Drug Tier 2: Preferred drugs

Drugs are listed as preferred becausethey havebeen proven to
be effective and favorably priced compared to other drugs that
treat the same condition.

>

One routine vision exam per benefit year at no cost

One frame and one pair of lenses per benefit year or
contact lenses instead of frames and lenses
- Up to $130 for one frame per benefit year (80%
coinsurance for covered charges more than $130)

Drug Tier 3: Non-preferred drugs

Non-preferred drugs have not been found to be any more

- Up to $130 per benefit year for non-medically

necessary contact lenses (85% coinsurance for
covered charges more than $130)

cost effective than preferred brands.

>

Preferred specialty and non-preferred specialty drugs

Preferred specialty drugs have been proven to be effective

and favorably priced compared to other drugs that treat the

same condition.
Non-preferred specialty drugs havenot been found to be any

more cost effective than preferred specialty drugs. You must

get your specialty drugs from one of two specialty pharmacy
providers, Hy-Vee PharmacySolutions (HPS)or CVS Caremark
Specialty Pharmacy. Both are experts that specializein the
delivery and clinical managementof specialty drugs.
To find out more, visit WeI/mark. com and view the WeI/mark Drug
List. Be sure to look at the Blue Rx Essentials drug plan.

10 I Plan Comparison Guide 2016

Medically necessary contact lenses

To find out if your provider participates in the pediatric vision
plan, visit WeI/mark. com and click on "Find a Doctor or
Hospital". Then click on "Vision Providers (Avesis)" under
the "Other" category.
These policies do not include pediatric dental services as described under
the federal Patient Protection and Affordable Care Act. This coverage is
available in the insurance market and can be purchased in a stand-alone
product. Please contact your insurance carrier, producer or Iowa's
Partnership Marketplace Exchange if you wish to purchase pediatric
dental coverage or a stand-alone dental service product.
I

Well mark's pediatric vision coverage is administered by Avesis, an independent company

providing network and claims administration on behalf of Wellmark for the pediatric vision
benefits.

What else is covered?

Here's a high-level look at what's covered by Wellmark's health plans. You will receive a complete list with
your policy manual once you enroll in a Wellmark plan. For detailed cost information look at your Summary
of Benefits and Coverage(SBC).

>

>

Physician services

>

Organ and tissue transplants

Anesthesia services

Heart

Physician office and outpatient visits

Lung

Radiology

Pancreas

Pathology and other diagnostic services

Kidney

Surgery and surgical assistance

Simultaneous pancreas/kidney

Inpatient hospital visits

Small bowel

Physician office services

Liver

X-ray, laboratory and pathology services

performed in the physician's office

Bone marrow/stem cell transfers

>

Diabetesoutpatient self-managementtraining and

patient management from an approved provider

>
>

Physical,occupational or speech therapy services

Hearing exams due to illness or injury

Spinal manipulations (Limits may apply)

Eye exams due to illness or injury

>

Durable medical equipment

Supplies used to treat the covered person

during the visit

Allergy testing

Common exclusions
There are some services that are not usually covered by your health plan. We've listed the most common, but
for a detailed list, look at the policy manual you'll receive when you enroll in a Wellmark plan.

>

Services not determined to be medically

necessary

>

Routine vision services

Except as noted in the Pediatric Vision section

>
>

Elective abortions

>
>
>

Counseling

>
>

Artificial insemination; in vitro fertilization or any

related fertility or infertility transfer procedure
Massagetherapy
Cosmetic services
Except in the following instances; surgery that
has the primary purpose of restoring function
lost or impaired as a result of an illness or
injury, or birth defect. Breast reconstruction
after a mastectomy.

>
>
>

Investigational and experimental treatment

Wigs
Acupuncture
Weight reduction programs
Routine foot care

PlanComparisonGuide2016 I 11

Easy ways to pay

Once you decide on a Wellmark plan, you then have another choice - which easy way to pay fits you best.
All billing periods are based on the calendar year and you can make payments either:

o
o
e

Quarterly (Electronic FundsTransfer only)

Semi-annually
Annually
Monthly (Electronic FundsTransfer only)

You can even set up automatic withdrawal from a savings or checking account. If you would rather have a
paper bill, you can get those on a semi-annual or annual payment frequency.

What to expect next

You've picked your plan and made your payment selection, what's next?

o You'll receive your completed application. Check to make sure all of the information for both you and
your family members on your policy is correct.
o Watch for your Wellmark ID card in the mail. That card is packed with all the information you need.
Make sure everything is accurate, and show your card to your doctor, hospital or any other health care
provider to access your benefits.

Register for myWellmark - it takes just a few quick steps. myWeiI mark is your personalized health
website that makes it easyfor you to manageyour plan.

Members get even more options.

As a Wellmark member, we offer you opportunitiesto get more from your health care benefits.
Lean on our resources for more information, support and discounts when you need them.
Personal
Health
Assistant

2417

Any time you need help,

PersonalHealthAssistant
24/7 is here to answer
your health concerns,
direct you to providers
or resources, and offer
solutions for everyday
health care problems.

BlueCard
Program
With the BlueCard
program, you can travel with peace of
mind, knowingthat 96 percent of hospitals
and 92 percent of physiciansnationwide
are in the Blue Crossand Blue Shield
network.' With a PPOplan, you also have
accessto doctors and hospitals in more
than 200 countries aroundthe world. With
our Wellmark Blue HMO plans, you're
typically only protected in emergency
situations when traveling outside Iowa.

wellmark .

v.

Blue365.

myWell mark

Because health is a big deai

Blue365 Program
This member program
gives you exclusive
access to discounts and
resources to help you live
a healthier lifestyle. Visit
Wellmark.com/Blue365.
I

12 I PlanComparisonGuide 2016

myWeiI mark is your

personalized health
website that makes it
easy for you to
manageyour plan.
You can even access
it on your smartphone
by downloading the
Wellmark mobile app.

Blue Cross and Blue Shield Association, 2014.

HEALTH INSURANCE ASSESSMENT

Use this worksheet to assessyour health insurance needs.
HEALTH INSURANCE INFORMATION

o
o

If yes, do you... (Circleone) Buy it yourself / Purchasethrough an employer

What is your premium?

Do you have health insurance now?(Circle one)

/month;

o What is your deductible?

Copay

Out-of-pocket max

e
-0

Yes 1 No

Network

/year
Coinsurance

Pharmacy copay/deductibles:

If you had a major medical bill delivered to you today, how much could you spend toward your deductible or coinsurance?

How haveyou usedyour health insurance most often in the past year?

How many doctor visits did your family have last year?

Are you willing to consider a plan with higher out-of-pocket costs in return for a lower premium or would you prefer lower out-of
pocket costs at a higher premium?

Have you ever considered using a health savings account (HSA) for you and your family?
(Circle one) Yes / No / Don't know what an HSA is

Do you know if your family doctor, specialist or medical provider is in-network on your current plan?

4D

Do you, or any of your family members, currently receive medical services, or plan to receive medical services this year, from a
provider outside the state of Iowa?If so, who are the providers you plan on using?

Do you, or any of your family members travel outside the state of Iowa on a regular basis?If so, where do you travel most?

f.D

Do you have ongoing prescription drug costs?

If so, haveyou checked the Wellmark Drug List to see if the drugs are covered, on which tier, and at what cost-share?

I "')'1:\'/J.fill 11",,11"'-.

tIl

I'

IL'iil

PlanComparisonGuide 2016 I 13

Ready to enroll in a plan? Need help deciding?

We are here to help!
>

Talk to your authorized Farm Bureau agent or find one at Wellmark.com.

>

Visit Wellmark.com to compare your options, shop for a plan and get a personalized
rate quote. All you have to do is:

o
o

Compare your options by looking at available plans side by side.

Add your desired plan to the shopping cart and enroll.

Answer a few questions to help you decide which plan best fits your needs.

This documentis intended to be usedsolelyfor illustrativepurposes, and providessimplified informationand

examples of a general nature. It is not intended as legalor tax advice, nor as an indication that you are eligibleto
contribute to an HSA, and should not be construed as such. Consultyour tax advisor for specific tax adviceand
for more informationabout tax savings.
This brochure is a briefsummary of policiespresented, which are subject to exclusions, limitations,reductions
in benefits,and terms under which the policiesmay be renewed or discontinued.For costs and complete details
of the coverage,call or write your authorized insuranceagent or Wellmark.
Also, please note, this is a general descriptionof coverage.It is not a statement of contract. Actual coverageis
subject to the terms and conditions specifiedin the policyitselfand enrollmentregulations in force when the
policybecomes effective.

GET THE BEST OF BOTH

wellmark.+,'
Wellmark BlueCross Blue Shieldof Iowa :
Wellmark Health Plan of Iowa, Inc.

Products available

1.=

FARM BUREAU

at Farm Bureau Financial

Services

Wellmark Blue Cross and Blue Shield of Iowa and WellmarkHealth Plan of Iowa, Inc. are Independent Licenseesof the Blue Cross and Blue Shield Association.
Blue Cross", Blue Shield, the Cross and Shield symbols and BlueCard are registered marks and SimplyBlueSM, CompleteBlueSM, CompleteBlue MaxsM,
EnhancedBlueSM, EnhancedBlue MaxSM, myBlue HSAsM, Blue Rx Essentiats-" and Blue Rewards=' are service marks of the Blue Cross and Blue Shield ASSOciation,
an Association of Independent Blue Cross and Blue Shield Plans.
Wellmark is a registered mark of Wellmark, Inc.
2015 Wellmark, Inc.

M-53952 09115

BCBSI-150